Hyperglycosylated human chorionic gonadotropin as an early predictor of pregnancy outcomes after in vitro fertilization

Abstract

Objective To determine if hyperglycosylated hCG (hhCG), produced by invasive trophoblasts, measured as early as 9 days after egg retrieval can predict ongoing pregnancies (OP) after in vitro fertilization and fresh embryo transfer (IVF-ET). Design Cohort Setting Academic ART center Patients Consecutive patients undergoing IVF-ET Interventions Serum hhCG and hCG levels measured 9 (D9) and 16 (D16) days after egg retrieval Outcome Ongoing pregnancy (OP) beyond 9 weeks of gestation Results OP (62 of 112 participants) was associated with higher D9 levels of hhCG and hCG However, hhCG was detectable in all D9 OP samples, while hCG was detectable in only 22%. D9 hhCG levels >110 pg/mL was 96% specific for OP, yielding a positive predictive value of 95%. Compared to D9 hCG levels, hhCG was more sensitive and had a larger area under the curve (0.87 vs. 0.67). Diagnostic test characteristics were similar between D16 hhCG and hCG levels. Conclusions In patients undergoing assisted reproduction, a test to detect pregnancy early and predict outcomes is highly desirable. HhCG is detectable in serum 9 days after egg retrieval IVF-ET cycles. At this early assessment, hhCG is superior to traditional hCG and highly predictive of ongoing pregnancies.

Hyperglycosylated hCG: a Unique Human Implantation and Invasion Factor

“…In natural conception cycles, hCG‐H comprised 88% of total serum hCG in continuing pregnancies but only 44% in failing pregnancies on the first day of hCG detection . In IVF/ICSI cohort, serum samples taken as early as 9–16 days after oocyte retrieval (around day 4–11 after embryo transfer) could discriminate between an ongoing pregnancy and a pregnancy which would result in a spontaneous abortion . Measurements of hCG‐H can also discriminate between ongoing pregnancies, spontaneous abortions and biochemical pregnancies within 2 weeks following embryo transfer .…”

Hyperglycosylated human chorionic gonadotropin as a predictor of ongoing pregnancy

“…27 In another study with 46 patients following fresh day 3 or day 5 embryo transfers, median hCG-H levels were found to be significantly different at both 9 and 16 days following oocyte retrieval among ongoing and failed pregnancies (biochemical pregnancies and clinical pregnancy losses combined). 28 In this same study, using a retrospective cohort of 112 patients following fresh embryo transfer for confirmation, hCG-H >8165 pg/mL (8.2 ng/mL) 16 days after oocyte retrieval had a PPVof 96% for ongoing pregnancy and a NPV of 77%.…”

“…43 Serum hCG-H for prediction of pregnancy prognosis following IVF has also been explored to a limited extent, with hCG-H cut-offs of 6e8 ng/mL being reported to differentiate between ongoing and failed pregnancies. 27,28 In 1 study, a blinded prospective trial of serum hCG-H levels drawn in IVF patients 6 and 12 days after fresh day 3 or day 5 embryo transfers found that following blastocyst transfer (n ¼ 39), serum hCG-H 6 days (300 pg/mL) and 12 days ( >6000 pg/mL, or 6 ng/mL) after transfer predicted clinical pregnancy with a specificity of 100% and sensitivities of 92% and 88%, respectively. 27 In another study with 46 patients following fresh day 3 or day 5 embryo transfers, median hCG-H levels were found to be significantly different at both 9 and 16 days following oocyte retrieval among ongoing and failed pregnancies (biochemical pregnancies and clinical pregnancy losses combined).…”

“…[23][24][25][26] hCG-H has been explored to a limited extent as a marker of early pregnancy prognosis, although prior studies have several limitations: patient sample sizes have been small; transfers of multiple embryos have been included (which may result in multiple implantations that affect hCG levels); and embryos at different stages (cleavage-stage and blastocyst) have been included, whereas thawed embryos have been excluded, despite increasing use of cryo-embryo transfers due to excellent survival rates achieved with vitrification. [27][28][29][30] Furthermore, these prior studies did not consistently report or control for demographic and in vitro fertilization (IVF) cycle parameters (such as patient age and embryo quality) that are known to affect pregnancy prognosis.…”

Hyperglycosylated hCG in a Group of Iraqi Patients with Gestational Trophoblastic Disease

“…Sandy Chuan, M.D,2014,said that, in patient undergoing assisted reproduction , hCG-H is detectable in maternal serum 9 days after egg retrieval IVF-ET cycle, so hCG-H was superior to traditional hCG and highly predictive of ongoing pregnancies (48) . Our study finding reported higher hCG-H level in molar pregnancy in comparison with normal pregnancy.…”